Knee pain

anatomy

The knee cap (patella) is a small bone in the front of the knee. It glides up and down a groove in the thigh bone (femur) as the knee bends and straightens. The patella has a smooth coating (articular cartilage) on its underside which allows it to slide easily in this groove. The groove in the femur is called the femoral groove and it is also coated with articular cartilage. The patellar tendon is a thick, rope like structure that connects the bottom of the patella to the top of the large shinbone (tibia). The powerful muscles on the front of the thigh, the quadriceps muscles, straighten the knee by pulling at the patellar tendon via the patella. One of the quadriceps muscles, the vastus medialis, pulls the patella inward (medially). Another quadriceps muscle, the vastus lateralis, pulls the patella outward (laterally). There are also smaller rope like structures (ligaments) on the inner (medial) and outer (lateral) sides of the patella. These small ligaments work with the quadriceps muscles to help keep the patella in the centre of the femoral groove.

causes and symptoms

Patellofemoral pain is a common knee problem. If you have this condition, you feel pain under and around your kneecap. The pain can get worse when you're active or when you sit for a long time. You can have the pain in only one knee, or you can have pain in both knees.

Patello-femoral pain is usually caused by improper biomechanics during the contact phase of gait (when the foot is on the ground). It is often prevalent in running sports as the mechanics of running put great stresses on the knee. Even slight biomechanical problems can be magnified when doing sports that require periods of running.

treatment in the acute phase

If traumatic injury of the knee occurs immediate medical attention should be sought.

P - R - I - C - E

Protection - Your knee may be splinted, taped or braced to prevent further injury.

Rest - You should rest from all activities that cause pain or limping. Use crutches/cane until you can walk without pain or limping.

Ice - Place a plastic bag with ice on the knee for 15-20 minutes, 3-5 times a day for the first 24-72 hours. Leave the ice off at least 1 1/2 hours between applications.

Compression - Wrap an elastic bandage from the toes to mid calf, using even pressure. Wear this until swelling decreases. Loosen the wrap if your toes start to turn blue or feel cold.

Elevate - Make sure to elevate the knee above heart level

to restore normal function

Exercises should not hurt, if they do stop!

Here are some exercises to help your knee pain. After you do all the exercises as shown in the drawings, reverse your position, and do the exercises with your other leg, so both knees get the benefit of stretching

Hip abductor strengthening (left side shown, front and side views)

Position yourself as shown above, standing on your left leg with the knee slightly bent. Slowly raise your right foot about 30 degrees, hold for a few seconds, and then slowly lower the foot and straighten both legs. Don't let your pelvis tilt (be crooked), and don't let your knees turn inward during bending.

Repeat the exercises below several times with each leg on a daily basis. Over several weeks, increase the resistance by adding ankle weights or by looping purse straps or the handle of a weighted pail over your ankle. Start with one or two pounds, adding one-half pound at a time as you build strength.

Bent-Leg Raises

This strengthens the inner thigh muscle to balance the pull on the knee joint from the outer thigh, which is often stronger.

Sit on a chair and straighten one leg.
Hold for one minute.
Bend your knee to lower that leg about halfway to the floor (a 45-degree angle).
Hold for 30 seconds.
Return to starting position and rest for one minute.
Repeat.
Work up to four repetitions for each leg.

Straight-Leg Raises

This strengthens the thigh muscles to help support the knee joint.

Sit in a chair with one leg extended, resting your foot on a chair.
Lift that foot a few inches while keeping your leg straight.
Hold for 10 seconds.
Return to resting position for 10 seconds.
Repeat.
Work up to three minutes of lifting for each leg.

to prevent injury

Remember, many patello-femoral problems occur at contact phase of gait (when the foot hits the ground) due to increased biomechanical stress at this point. It is therefore vital to improve your biomechanics with orthotics designed for you chosen sport.

Golden rule- Don't ignore the problem, it won't go away!

The way we function biomechanically is predominantly controlled by genetics, its hereditary (runs in the family). The way you function is set and cannot be cured.

What you can do however is control lower limb biomechanics by altering foot position during the contact phase ofgait. This can only be done by wearing a good shoe (see our shoe guide) and with orthotics (foot beds). This is the cheapest and most cost effective way for any athlete to reduce the risks of injury from occurring and from helping to prevent re-injury. Overall costs for the average athlete will run into pennies per mile/hour of sport.

Orthotic are designed to alter the biomechanics during the time the foot is on the ground. They are also used to provide increased shock absorbency working in harmony with the sport shoe worn.

Consider purchasing a knee brace . This device provides extra stability to the knee when playing sports. The material also causes localised vaso-dilation (opening of the blood vessels) increasing circulation to the area. This is vital as all ligaments have a notoriously poor blood supply. Increasing circulation to the ligaments can reduce the chance of injury. Have a look at the kneebrace information page in our online store.

Wobble boards- Designed to improve proprioception these devices used as per the manufacturers instructions will improve the connection between the brain and the nerve fibres in the leg. Have a look at the wobble board information page in our online store.

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Check your running shoes, are they worn, how long have you had them? Trainers used for running are designed to last at most about 750 miles. If you think you have done more mileage then replace them with a new pair. Readthe running shoe page to get practical advice on running shoes.

returning to sporting activity

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your knee recovers, not by how many days or weeks it has been since your injury occurred.

You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:

You have full range of motion in the injured leg compared to the uninjured leg.

You have full strength of the injured leg compared to the uninjured leg.

You can jog straight ahead without pain or limping.

You can sprint straight ahead without pain or limping.

You can do 45-degree cuts, first at half-speed, then at full-speed.

You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.

You can do 90-degree cuts, first at half-speed, then at full-speed.

You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.

You can jump on both legs without pain and you can jump on the injured leg without pain.

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